Organization
WEST LINN CLEMENTINE, INC
Active
Other names
Clementine Portland
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE BAGLEY (CHIEF FINANCIAL OFFICER)
(305) 663-1876
Entity
Organization
Contact information
Practice address
1148 ROSEMONT RD, WEST LINN, OR 97068-9235
(971) 249-8448
(503) 305-7100
Mailing address
6100 SW 76TH ST, SOUTH MIAMI, FL 33143-5002
(305) 663-1876
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
OR
Other
Enumeration date
08/05/2016
Last updated
03/04/2020
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